Linda M S Resar1,2,3, Elizabeth C Wick4, Talal Nael Almasri5, Elizabeth A Dackiw6, Paul M Ness5,7, Steven M Frank6. 1. Department of Medicine (Hematology), the, Baltimore, Maryland. lresar@jhmi.edu. 2. Department of Oncology, the, Baltimore, Maryland. lresar@jhmi.edu. 3. Institute for Cellular Engineering, the, Baltimore, Maryland. lresar@jhmi.edu. 4. Department of Surgery, the, Baltimore, Maryland. 5. Department of Medicine (Hematology), the, Baltimore, Maryland. 6. Department of Anesthesiology/Critical Care Medicine, and the, Baltimore, Maryland. 7. Department of Pathology (Transfusion Medicine), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Abstract
BACKGROUND: Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery. STUDY DESIGN AND METHODS: Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses. Anemia is treated with erythropoiesis-stimulating agents as well as iron, folate, and B12 when indicated. Low-volume phlebotomy tubes are used for laboratory testing. Autologous blood salvage is used for childbirth and surgical patients who have the potential for substantial bleeding. RESULTS: Although there have been few retrospective studies and no prospective studies to guide management, prior studies suggest that outcomes for surgical patients managed without ABTs are comparable to those of historic controls. CONCLUSIONS: Given the emerging evidence that patients who avoid ABTs do as well if not better than patients who accept ABTs, further efforts are needed to determine whether all patients could benefit from bloodless strategies. Bloodless approaches in selected patients could reduce risks, improve outcomes, and decrease costs for all patients.
BACKGROUND: Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery. STUDY DESIGN AND METHODS: Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses. Anemia is treated with erythropoiesis-stimulating agents as well as iron, folate, and B12 when indicated. Low-volume phlebotomy tubes are used for laboratory testing. Autologous blood salvage is used for childbirth and surgical patients who have the potential for substantial bleeding. RESULTS: Although there have been few retrospective studies and no prospective studies to guide management, prior studies suggest that outcomes for surgical patients managed without ABTs are comparable to those of historic controls. CONCLUSIONS: Given the emerging evidence that patients who avoid ABTs do as well if not better than patients who accept ABTs, further efforts are needed to determine whether all patients could benefit from bloodless strategies. Bloodless approaches in selected patients could reduce risks, improve outcomes, and decrease costs for all patients.
Authors: Steven M Frank; Robert A Sikorski; Gerhardt Konig; Diamantis I Tsilimigras; Jan Hartmann; Mark A Popovsky; Timothy M Pawlik; Jonathan H Waters Journal: J Gastrointest Surg Date: 2019-08-29 Impact factor: 3.452
Authors: Marley Ribeiro Feitosa; Lucas Fernandes de Freitas; Antonio Balestrim Filho; Guilherme Seizem Nakiri; Daniel Giansante Abud; Ligia Magnani Landell; Mariângela Ottoboni Brunaldi; Jose Joaquim Ribeiro da Rocha; Omar Feres; Rogério Serafim Parra Journal: World J Clin Oncol Date: 2020-12-24